dr. fulsen bozkuŞ akdeniz university medical school
DESCRIPTION
Effect of Upper Airway Location, Identified by Flextupe Reflectometry, on CPAP Pressure in Obstructive Sleep Apne Syndrome Patients. Dr. Fulsen BOZKUŞ Akdeniz University Medical School. Obstructive Sleep Apne Syndrome. - PowerPoint PPT PresentationTRANSCRIPT
Effect of Upper Airway Location, Effect of Upper Airway Location, Identified by Flextupe Identified by Flextupe
Reflectometry, on CPAP Pressure in Reflectometry, on CPAP Pressure in Obstructive Sleep Apne Syndrome Obstructive Sleep Apne Syndrome
PatientsPatients
Dr. Fulsen BOZKUŞAkdeniz University Medical School
Obstructive Sleep Apne Syndrome
It is a syndrome characterized by repeated upper airway obstruction and frequently accompanied by decrease in oxygen saturation.
OSAS PREVALENCE
~% 2-4
Results of OSAS
Cardiovascular Pulmonary Pulmonary results Neurologycal Neurologycal results Psychiatric Psychiatric results Endocrynological results Nephrologycal results Gastrointestinal results Hematologycal results Socioeconomic results Mortality Other
A DISEASE A DISEASE THAT SHOULD THAT SHOULD
ABSOLUTELY BE ABSOLUTELY BE TREATED TREATED
OSAS Pathophysiology
The airway wall is drawn inside with the negative intraluminal pressure composed during inspiration and decrease in oropharengeal muscle tonus.
OSAS Pathophysiology
Oclusion develop and apnea occur via the progresive increase of airway resistance.
OSAS Pathophysiology
It is thought that continuous positive pressure applied to upper airway can resolve that oclusion.
CPAP TreatmentCPAP Treatment
Sullivan et. al, gave continuous pressure to upper airway with a nasal mask and inhibited pharynx wall collaps and so apnea.
Upper airway obstruction Upper airway obstruction locations in OSASlocations in OSAS
RetropalathalRetropalathal RetrolingualRetrolingual MixMix
Flextube reflectometryFlextube reflectometry ((RhinosleepRhinosleep))
It is a technique that objective, It is a technique that objective, done during sleep,easy to do, done during sleep,easy to do, easy to tolerate,can show easy to tolerate,can show obstruction location and/or obstruction location and/or locations at the same time.locations at the same time.
Rinosleep equipment anterior (left) and posterior appearance (rigth)
Rinosleep equipment lateral, miniprobe (left lower) and pump used in rinoflex tube attachment (left upper)
Marking of nasal cavity length in Flextube reflectometry
Rhinoflex tube “0” point should be placed ritghly, uvula length marked and tube placed
Rinosleep study principle.
AIMAIM
To determine if there is an effect of upper airway location, identified by flextupe reflectometry, on CPAP pressure in obstructive sleep apne syndrome patients or not.
Material - MethodMaterial - Method
July 2005 – December 2007July 2005 – December 2007 AUMS Chest Medicine – ENT AUMS Chest Medicine – ENT
clinicsclinics Patient that OSAS was Patient that OSAS was
diagnosed and CPAP is indicated, diagnosed and CPAP is indicated, were included.were included.
Retrospective and prospectiveRetrospective and prospective
Material - MethodMaterial - Method
Questionnaire for patient and friendQuestionnaire for patient and friend Epworth slepiness scale > 12 Epworth slepiness scale > 12
PSGPSG AHİ>30 and AHİ 5-30 with day time AHİ>30 and AHİ 5-30 with day time
slepiness CPAP titrasyonuslepiness CPAP titrasyonu Upper airway obstruction locationUpper airway obstruction location
flekstube reflectometryflekstube reflectometry
Material - MethodMaterial - Method
Obstruction number and Obstruction number and obstruction locations:obstruction locations:
Retropalathal (0-4 cm)Retropalathal (0-4 cm) Retrolingual (4-9 cm)Retrolingual (4-9 cm) MixMix
VFO determined with rinosleep
DKO determined with rinosleep
mix obstruction determined with rinosleep
Material - MethodMaterial - Method
Exclusion criteriasExclusion criterias Polysomnography and rhinosleep Polysomnography and rhinosleep
records technically inadequate records technically inadequate patientspatients
>3 months between >3 months between polysomnography and rhinosleep polysomnography and rhinosleep
Material - MethodMaterial - Method
Any other treatment other than Any other treatment other than corrective obstruciton surgery corrective obstruciton surgery applied between applied between Polysomnography and rhinosleepPolysomnography and rhinosleep
Remarkable weigth difference Remarkable weigth difference between Polysomnography and between Polysomnography and rhinosleeprhinosleep
Material - MethodMaterial - Method
Patients with COPD (Overlap Patients with COPD (Overlap Syndrome), chest wall deformity, Syndrome), chest wall deformity, airway obstruction and airway obstruction and paranchymal lung diseaseparanchymal lung disease
Psychiatric problems and/or Psychiatric problems and/or sedative drug usagesedative drug usage
Material - MethodMaterial - Method AgeAge SexSex BMI (kg/m2)BMI (kg/m2) Neck CircumferenceNeck Circumference Epworth Slepyness Scale Epworth Slepyness Scale AHI AHI Obstruction locations and number, Obstruction locations and number,
determined by Rinosleep determined by Rinosleep CPAP titration pressureCPAP titration pressure
FindingsFindings
Total 102 patientsTotal 102 patients 40 patients accepted 40 patients accepted 7 patients excluded7 patients excluded 33 patients included33 patients included 28 (%84.84) male, 5 (%15.16) 28 (%84.84) male, 5 (%15.16)
femalefemale
Parametre Minimum Maximum mean SD*
AGE (year) 33 74 51.55 10.417
BMI (kg/m2) 24.60 41 31.14 3.666
Neck circumference(cm) 39 48 42.52 2.347
CPAP pressure(cm h20) 5 15 11.18 2.910
EPWORTH sleep scale 3 24 12.67 5.521
AHI 15.10 81.40 45.875 19.076
Rinosleep obstruction number 5.8 80.0 36.32 18.06
* Değişkenler ± SD olarak verilmiştir.
Schedule 1. patients demographic data
With Flextube reflektometry 9 With Flextube reflektometry 9 patients (%27.2) retropalathal, patients (%27.2) retropalathal, 12 patients (%36.3) retrolingual 12 patients (%36.3) retrolingual and 12 patients (%36.3) mix and 12 patients (%36.3) mix obstruction. There was no obstruction. There was no significant correlation between significant correlation between obstruction locations and obstruction locations and obstruction number (p:0,886) obstruction number (p:0,886) (schedule 2.). (schedule 2.).
obstruction location determined by rinosleep
Patient number (n=33)/ %
obstruction number determined by rinosleep
(Ort±SD)
VFO 9 / 27.4 33,37 ± 12,34
DKO 12 / 36.3 36,02 ± 19,45
MİX 12 / 36.3 38,83 ± 21,12
Schedule 2. patients obstruction locations and number determined by rinosleep
0
5
10
15
20
25
30
35
40
VFO DKO MiX
Figure .1. Obstruction locations determined by rinosleep.
There was no significant There was no significant difference between patients difference between patients according to obstruction according to obstruction locations in respect to age, sex, locations in respect to age, sex, BMI, AHI, Epwoth sleep Scale, BMI, AHI, Epwoth sleep Scale, neck circumferenceneck circumference
There was a statistically There was a statistically significant correlation between significant correlation between obstruction number determined obstruction number determined by flextube reflektometry and by flextube reflektometry and AHI obtained with PSG . (pearson AHI obtained with PSG . (pearson correlation coefficient, r:0.451, correlation coefficient, r:0.451, p:0.008) (figure 1.)p:0.008) (figure 1.)
80,0060,0040,0020,00
80,00
60,00
40,00
20,00
0,00
AHI determined by PSG
o: intersections between AHİ determined by PSG and obstruction numbers determined by rinosleep
Figure 2. Obstruction numbers determined by rinosleep and AHI determined by PSG.
When patients are categorised according When patients are categorised according to obstruction locations; to obstruction locations;
CPAP pressure in RCPAP pressure in Retrolingual group was etrolingual group was statistically higher than in Retropalathal statistically higher than in Retropalathal group, (p:0,003) group, (p:0,003)
CPAP pressure in Mix obstructionCPAP pressure in Mix obstruction group was group was statistically higher than in Retropalathal statistically higher than in Retropalathal group (p:0,001)group (p:0,001)
obstruction location determined by rinosleep
MinimumCPAP
pressure
MaximumCPAPpressure
Mean CPAP pressure
SD*
VFO 5 11 8,22 * ⁿ 1,98
DKO 9 15 11,58 * 2,31
MİX 9 15 13 ⁿ 2.33
* p:0.003 ⁿ p:0.001
Schedule 3. Obstruction locations and mean CPAP pressures.
MİXTONGUE BASE GROUPSOFT PALATE GROUP
cp
ap
p
ressu
re
15
12,5
10
7,5
5
schedule.3. CPAP pressure distribution according to obstruction locations determined by rinosleep
Conclusion
Tongue base obstruction migth be one of the reasons that increase CPAP titration pressure in OSAS
In patients who can not tolarate CPAP with flekstube reflektometry we can determine obstruction location, and if it is retrolingual obstruction, we can plan treatment modalities ( radyofrequency, tongue base suspension,...) to the tongue base.